Provider Demographics
NPI:1649976317
Name:RYAN, SANJA (NP)
Entity type:Individual
Prefix:
First Name:SANJA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SANJA
Other - Middle Name:
Other - Last Name:STUBLIC RYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:507 PIER AVE
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3822
Mailing Address - Country:US
Mailing Address - Phone:310-498-4113
Mailing Address - Fax:
Practice Address - Street 1:1777 N BELLFLOWER BLVD STE 109
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4019
Practice Address - Country:US
Practice Address - Phone:692-498-4455
Practice Address - Fax:562-498-4499
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023054363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner